Temporal association of premature ventricular contraction burden measured by an insertable cardiac monitor with episodes of ventricular tachycardia and fibrillation
S A Saha, J W Dukes, D R Lakkireddy, E W Aabel, N V K Pothineni, P Zimmerman, S Sarkar, M Deus, G Rajagopal, Y Cho, D L LustgartenAbstract
Background
Insertable cardiac monitors (ICM) have the capability to continuously monitor PVC burden over time as well as detect ventricular tachycardia and fibrillation (VT/VF).
Objective
We investigated the temporal association of PVC burden with incidence of VT/VF in a large real-world cohort of patients implanted with ICMs.
Methods
Patients implanted with an ICM for various monitoring reasons and with PVC detection enabled were included from a de-identified device data warehouse. Tachycardia episodes detected by the ICM were first evaluated using an artificial intelligence (AI) model pre-trained using >50,000 adjudicated ICM detected Tachycardia episodes. If the AI-model output probability for VT/VF was greater than 0.2, then those episodes were manually adjudicated for true incidence of VT/VF. A within-patient case-crossover design compared each patient’s first VT/VF date with a control date 120 days prior. Conditional logistic regression analyzed the relationship between VT/VF and maximum daily PVC burden in the 7 days preceding the VT/VF episode or control date.
Results
A total of 14,125 patients (average age: 66.5±15.1 years, 50% males) were included in the analysis, of which 13,552 patients never had VT/VF, and had significantly lower overall PVC burden than patients with true VT/VF (Figure). A total of 1322 true VT/VF episodes in 573 patients were identified after AI-model probability based manual adjudications, of which 299 patients were identified with at least 150 days of PVC burden data before their first true VT/VF episode. Among these patients, maximum daily PVC burden in the 7 days prior to their first VT/VF episode was 32% higher than in the 7 days prior to the control date (p=0.005). A 1% increase in maximum daily PVC burden was associated with a 14% increase in the odds of VT/VF (OR: 1.14 95% CI:1.05-1.24, p=0.001). Additionally, a 7-day maximum daily PVC burden of >=10% was associated with a >6-fold increase in the odds of developing VT/VF (OR: 6.33 (1.87-21.4), p<0.001).
Conclusions
PVC burden was significantly higher in patients with VT/VF than those with no VT/VF, and further increased in the 7 days prior to occurrence of their first VT/VF episode. Having at least one day with PVC burden >=10% during a 7-day period was associated with more than a 6-fold increase in the odds of acute-onset VT/VF. Temporal characteristics of continuously monitored PVC burden in ICMs may be used as a tool to identify patients at risk for VT/VF.